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咳嗽诱发的逼尿肌过度活动——保守治疗和手术治疗后的结果

Cough-Induced Detrusor Overactivity-Outcome after Conservative and Surgical Treatment.

作者信息

Villiger Anna-Sophie, Fluri Mihaela Madalina, Hoehn Diana, Radan Anda, Kuhn Annette

机构信息

Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.

出版信息

J Clin Med. 2024 Oct 14;13(20):6109. doi: 10.3390/jcm13206109.

Abstract

: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. : We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. : Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, < 0.001). The result was more favorable after periurethral bulking than the midurethral sling ( < 0.001). : This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence.

摘要

混合性尿失禁最常见的类型是压力性诱发急迫性尿失禁,其相关尿动力学表现为咳嗽诱发逼尿肌过度活动(CIDO)。这项前瞻性研究评估了CIDO患者在接受保守治疗或手术治疗后的临床结局及漏尿改善情况。

我们将2018年1月至2021年7月在我们三级转诊中心接受治疗的CIDO患者纳入了这项前瞻性队列研究。通过尿动力学多通道检测,咳嗽后检测到逼尿肌收缩被诊断为CIDO。我们研究中的所有患者均接受个性化护理,第一步是行为疗法和抗胆碱能/β拟交感神经药物治疗。如果漏尿持续存在,患者可在盆底肌锻炼(PFME)、尿道周围填充或中段尿道吊带术之间做出选择。主要结局是治疗前和治疗后6个月垫试验中尿漏的平均差异。

35名患者符合CIDO纳入标准,且在基线时所有患者的垫试验均呈阳性(平均:27克)。所有35名患者均接受了行为疗法和抗胆碱能/β拟交感神经药物治疗。22名患者(62.9%)接受了PFME,12名患者(34.2%)接受了尿道周围填充,9名患者(25.7%)接受了中段尿道吊带术。所有治疗后,我们的队列在垫试验中显示出显著改善(平均:5.7克,<0.001)。尿道周围填充后的结果比中段尿道吊带术更有利(<0.001)。

这项研究表明保守治疗作为第一步是有效的。在需要进一步治疗的情况下,填充剂可能优于PFME和中段尿道聚丙烯吊带,为妇科泌尿学和尿失禁领域提供了新的视角。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8ba3/11508877/f664ab87bc67/jcm-13-06109-g001.jpg

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